Which Role for Muscle-Sparing Posterolateral Thoracotomy in the Treatment of Spontaneous Pneumothorax?

Ibrahim Issoufou; Rabiou Sani; Daouda Amadou; Kadre Alio; Kaled Adamou-Nouhou; Marouane Lakranbi; Rachid Sani; Yassine Ouadnouni; Habibou Abarchi; Mohamed Smahi

doi:10.1055/s-0043-1770954

Which Role for Muscle-Sparing Posterolateral Thoracotomy in the Treatment of Spontaneous Pneumothorax?

Surg J (N Y). 2023 Dec 28;9(4):e149-e155. doi: 10.1055/s-0043-1770954. eCollection 2023 Oct.

Authors

Ibrahim Issoufou¹, Rabiou Sani¹, Daouda Amadou², Kadre Alio^{3

4}, Kaled Adamou-Nouhou², Marouane Lakranbi^{1

5}, Rachid Sani^{4

6}, Yassine Ouadnouni^{1

5}, Habibou Abarchi^{4

7}, Mohamed Smahi^{1

5}

Affiliations

¹ Department of Thoracic Surgery, Teaching Hospital Hassan II, Fez, Morocco.
² Department of Cardiovascular Surgery, Teaching Hospital Hassan II, Fez, Morocco.
³ Department of Stomatology and Maxillofacial Surgery, Hôpital Général de Référence, Niamey, Niger.
⁴ Department of Surgery and Surgical Specialities, Faculty of Health Sciences, Abdou Moumouni University, Niamey, Niger.
⁵ Department of Surgery, Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Adellah, Fez, Morocco.
⁶ Department of General Surgery, National Hospital of Niamey, Niamey, Niger.
⁷ Department of Pediatric Surgery, Hospital Amirou Boubacar Diallo, Niamey, Niger.

Abstract

Objective This study aims to show the place of muscle-sparing posterolateral thoracotomy in the treatment of spontaneous pneumothorax. Methods It was a single-center study performed in the Department of Thoracic Surgery of Teaching hospital Hassan II of Fez for 8 years. We adopted the nosological definition, which classifies spontaneous pneumothorax into three categories. We included patients over 15 years of age with primary or secondary spontaneous pneumothorax operated by posterolateral thoracotomy without muscle section, and we analyzed the specific indications of this approach. It included 49 patients with primary or secondary spontaneous pneumothorax, operated by muscle-sparing posterolateral thoracotomy. Data were collected from regularly updated computer files of patients, entered by Excel 2013, and analyzed using SPSS.20 software. These data are: epidemiological, clinical, radiological, surgical exploration, surgical procedure, the result of the surgery and the evolution. Results The average age was 42 years. Smoking was found in 61% of cases and pulmonary tuberculosis in 10% of cases. Thoracic computed tomography (CT) showed bullae and blebs in 31% of cases, pleural adhesions and pachypleuritis in 50% of cases, and hydropneumothorax with pachypleuritis in 37% of cases. There is a statistical correlation between pleuropulmonary decortication and pachypleuritis ( p = 0.002) or hydropneumothorax ( p = 0.001) on CT. Bullae and blebs resection was performed in 53% of cases and pleuropulmonary decortication in 63% of cases. A right pleuropneumonectomy was performed in one case. The follow-up was uneventful in 82% of cases. Conclusion Muscle-sparing posterolateral thoracotomy remains the best approach and leads to good results.

Keywords: pleural tuberculosis; pneumothorax; spontaneous pneumothorax; thoracocentesis; thoracotomy.

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